HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: CLQ Permit Number:
Building Permit Application
DECEIVE®
Planning and Development Services JUN 2 4 2015
Building and Code Regulatian Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
.PERMIT APPLICATION FOR: Renovation 17771
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PR4pOSE-D,INC'P�ROu€MEN`F�OCATICrN ,u �r r � �,
Address: 7667 Pelican Point Drive, Jenson Beach Florida 34957
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Property Tax ID#: 25. 2–WO– Ot4 –0 00 Y Lot No.
Site Plan Name: Block No.
Project Name: Bath remodel
Setbacks Front Back: Right Side: Left Side:
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itiona wor to e e orme un er t is permit–c ec a appy:
HVAC Gas Tank Gas ng _Shutters Windows Doors
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Electric 0 Plumbing Sprinklers a Generator Roof
Total Sq. Ft of Construction: . Ft.of First Floor:
Cost of Construction: $ $250.00 Utilities. —Sewer Septic Building Height:
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SSEE s � �, ;��� � r �-f r ��.�� � ���.., s. �x,., r, .,W. ...,. .,.,.. ,o. ... ;:,n.., xz,f, ..<r...�:,�. ;«nce Name: Paul Shaughnessy
Pelican Point Drive Company: United Plumbing Solutions LLC
Beach State:FL Address: P.O. Box 1827
Zip Code: 57 Fax: City: Palm City State:FL
Phone No. Zip Code: 34991 Fax: 772-679-0212
E-Mail: Phone No. 772-905-4442
Fill in fee simple Title Holder on next page(if different E-Mail: office@ups-plumbing.com
from the Owner listed above) State or County License: CFC-1426338
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
�SUPPLEII/IENTAL;CONSTRUCTIO(�,LIEIU SAW INF4RMATI!ON, � � � f
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY•. _Not Applicable
Name: ' Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a.permit will authorize thepermit holder to build the subject structure
which is in conflict.with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney beffte
commencing work or recording our Notice of Commencement.
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_Signature of Owner see/Agent Signature of Contrac icense Holder
STATE OF FLORI STATE OF FLORIDA
COUNTY OF � ? '/�'.� pco— ?,
COUNTY OF
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The fo1going instrument was acknowledged before me.The forgoing inst ent was acknowledged beforthis dayof20 Jy:b this day of ' Q ,20. .by
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r(Narrihof person ackn�o�y►(edging) m (Name of person ackn ledginMIN � 'rt
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( ignature of otary Public-State of Florida} (Sig ature of Notary P lic-State of Florida)
Personally Known OR Pr�y�ed dentifi ation Pers nally Known OR Produced Identifigatio�
Type of Identification Produced d i� Type of Identification Prod�)PAd0 O A/1 /
Commission No. (Seal) Commission No.
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DATE
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